Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION Citystate Centre Bui lding, 709 Shaw Boulevard, Pasig City

Healthline 441-7444 WWW .Q~p_h

PHI~HEALTH CIRCULAR No. OOOG s. 2014

~ TO

SUBJECT

ALL PHILHEAL TH MEMBERS, ACCREDITED HEALTH CARE PROVIDERS, PHILHEALTH REGIONAL OFPICES (PROs) , AND ALL OTHERS CONCERNED

SUPPLEMENT TO PHILHEAL TH CIRCULAR 34, S.2013 : GUIDELINES ON THE PROVISION OF SPECIAL PRIVILEGES TO THOSE AFFECTED BY A FORTUITOUS EVENT INCLUDING SPECIFIC PROVISIONS FOR THOSE AFFECTED BY TYPHOON YOLANDA.

T n order to facil.ita te the imp icmema tion n f Phil Health Circular (PC) 3+ s. 2013, the follm\ ing supplemental prcwisions ro t·hc Cuidelines on the J)ro,·ision of Special Pri1·ilegcs to those Affected lw a Fortuitous 1 •:n :m arc hereb,· issued. - .

I. CLARIFICATION: )-\. lmproYised / satellite facilmes shall be limited only to those put-up and managed b}·

accredited health care insti tutions (HCTs) or non-accredited HCis licensed by DOH or certified lw a bod r recognized b\ Phill-lealth to relocate patients because the facilin was destroyed / unstable or augmenr th e need for more beds during fortuitou s e1·ents.

B. Less than 24 hours confinements (e~cludes outpatient consulrs) shall be reimbursed subject to the C\·aluanon of the submitted justification per claim b~· the Benefits "-\dministr:nion Secoon (B \S) of the PROs. This shall be paid a fixed amount of +,OO!l pesos.

C. Inactive and / or non -members mm ;~utumat.icall\ · be accorded with PhilHealth benefits as prescribed b~· the Corporation prm·idcd the patient/ head of the fa milr will submit a dul r accomplished Phill~lcalth i\Iembersh1p Registration Form (Pi\IRF).

D. Option fnr pa1 n1l'nt f,n dcstrm cd claims

O ptio n 1:

Option 2 :

Reconstru ctio n / recm·cn· of c.lestro\' ed claims for submission / filing to Phili-Jcalrh within 120 calendar da1·s from date of discharge of patienrs for the con·nd period (from 60 dars prior to ftrst day of occufrcncc of the fnnuitous c1-c11t up to t·he first cbr of occurrence of the fortuJtous event). Pm·mcnt of c!cstm1cd claims based on the a\-erage reimbursement per dm· tmdtip li ed br the number of dan of the coYered period (from (J(l

da rs prior to first da\ of occurrence of the fortuitous eYent up to the first da 1· of occurrence Cl f t"11e fortuitous cTent).From the comp uted amoum, all claims paid and rccci\-cd b\· the health care institutions for admitted and di :;ckt rgcd p:1tic11ts \\·ithin the cm·crcd penod shall be deducted.

For both op tions 1 and::.' . all clirccth tiled claims for and br members shall be reimbursed .

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F. ;\11 claims of patienrs adtniHed and subse<.Juently discharged prior to the co1·ered period due for p:wment shall still be reimbursed ro th e HC ls.

II. GENERAL GUIDELINES (applicable to ALL fortuitous events) r\. Health care in sr-irutions, e\ en those nor directh· affected br fortuitous cYcnrs but :Hl·

taking care of those affcucd br rhe fortuitous en:nt shall be cm·crecl by the app[jcabk special pr.i,·ilcgcs in Section \'1 of PhilHealth Circular 34, s. 20"13.

B. Following :t fortuitou s eYent, the Corporation ma1· issue a Circular cnume.rating the appLcablc special pnYikges. Health care m stitutwns may send their letters of request e\' en in the >1bsence of am C:ircul:u or 1ssnance from the Corporation.

C. ln cases when the Phi!He:llth offices arc also affected by the fortuitous e\·enr, 1"11c

fl.pplicabk special pri1· ilcges may also be implemented. "\ffected 1-ICls shall be norifted by the Corporation.

D. Tbe Corpora tion may ad d new special pridegcs or alter those enumerated :ls applicable to the fortuitou s cTcn r.

III. ADDITIONAL PRIVILEGES SPECIFIC TO THOSE AFFECTED BY TYPHOON YOLANDA (HAIYAN)

A. MEMBERSHIP, CONTRIBUTION AND BENEFIT ENTITLEMENT 1. All those :lffected b, Typhoon Yolanda (Phil Health members and non-members)

shall be granted ma:--:imum flcxibilm· regarding documentarv requirements as proof of membership or contribution un til December 31, 2013. A separate Circular shall be issued for the e:--:tension of the 1111plemenmtion of this pri,,ilege as needed.

2. For formal sector ( cmplon:~d members) if employer's office is based in calamin areas. Emplo)'er certification/ signature need not be required prm·ided that member record is confirmed thru:

1. Health Care Institutional Portal ii. ICares/PCares

3. Tl1o~c availing bc.ncfits 1n health care it1stitt1tions that are i11 areas I)IJZI~C'l~J ..~\ '

affected by Typhoon Y obnda shall be granted full benefit entitlement regardless of membership or eligibility status.

4. Those :lYailing benefits in heal th care institutions that :lre in areas NOT affected ]) , Trphoon Yolanda shall be granted full benefit entitlement once certified br anr of the following Phil f-1 calrh personnel:

1. Phill-f ealth Cares assigned to the health care institution ii. Loc:l] Health lnsurance Office head

tii. Authorized Phili-Iealth Regional Office personnel _ 5. Deadline for parment of contributions due on the month of Nm·ember 2013 or on

the 4' 11 Quarter of 2013 for those in the EMPLOYED SECTOR shall be extended until March 31, 2014 in directly hit areas.

o. Premium contributions fm the non-emplmcd is not a rec1uirement during the time of m·ailmenr for a period prescribed by the Corporation through the \ 'icc Presidcnts/ Regwnal \ ' icc President of the concerned PROs.

B. PROCESSING OF PER FAMILY P~YMENT (PFP) FOR PRIMARY CARE BENEFIT 1 (PCB1 PROVIDERS THAT ARE AFFECTED BY FORTUITOUS EVENT

1. Th e PRO shall certif1 that the PCB1 f1 >rtuitous c\·cn t.

I PhiiHMltfll 09ftoe-h PCEO I

The PRO shall facilitate the release of pending/ on process PFP for :1ffectcd :-~rc·as Pan11ent of PFP sh:-~11 contlnm· to follow the guidelines set in Phil Health Circular 7, s. 20)', re: Cuiclelinc::: fm Parmenr of Priman- Care Benefit l(PCBI ) Per

Familv Pavnwnl (Pl ·P) for -~th C~uaner of 2012 and CY 20U. 1-lmn.·\-er, if the PCB 1 records for lhe penod cm·ered ])\' the fortuitous c\·ent were destHl\Td , the PlZO may pa1· the PCBJ pnwidcr based on the amount of PJ ;p computwl for till'

C]LI:lrt'Cr pn.THlliS to rhe fortuitous e1·enr. Therefore, such process shall 11< lt

reqlllre submission of reports b1 the PCB 1 proYidcr for the applic1plc periocl only.

/< :; . RHL1 ;\,a PCHJ prm·idcr \\·as affected b1· ma:::si,·e flooding brought ;1bout

br T1·phoon Yobncb last NoYember 2013 (4'11 quarter of 2(JL1) thus resulting to destroyed don1mcnt;; including patient's records. The released P 1 ;p for lZ I II · . \ for the 2nd qu:uler of2(JU amounted ro P20,000. Since lZJ-11_' .-\is nor c:1p:1hk (>I' submitting the rec1uired reports for the release of PFP of .)'d quarter of 2tl 1.1, PRO shall process rhe PFP eLJUI\ ;llenr ro the 2"'1 c.1uarter of 201.) 1vhicb amoumed to P20;(1()(} _:_rhc~samc amount shall be released for PFP of the 4' 11 quarter 2() 11

unless lU-ll' A shall be able ro submit the required documents.

3. Disposition of J)J ·' ])shall be used based on guidelines set in I)hilf-Icalth C:ircular 10 s. 2012 re: Implementing Cuidelines for Universal Health Care Vnm;m· Cnc

Benefit I (PCB!) Package for 'fransition Period CY 2012-2013.

C. MATERNITY CARE BENEFITS

1.

3.

4.

To ensure :1cccss ro safe, facilm -bascd deb·eries, PhilHealth shall pa1· the normal deh1·ery of mothers, regardless of maternal parity of the same, whether <1\ ailed of

in hospitals as Normal Spontaneous DeliYerY (NSD) Package or non-hospital faciliues as Maternity Care Package (T\fCP). Entitlement to these benefits shall be according to Sections IIL\.2 and I I L\ .. l of

this circular.

To facilitate the processing of cbims, HCT should write / stamp on the nght upper hand corner of Claim Form 2 the words "affected b\ fortuitous event (T1 phoon

Yolanda)" . l\.la rernal conditmns rhar \vill1ncrease the risk of complications during deli' en as enumerated in Scctlon T.!Ll of C:1rcular 20 s, 2008 shall remain excluded in J\ ICP. Normal Ddi,·en· eYen rf bc1 ond 4' 11 1:-; compensable as J\ICP as long as it is lm1 risk and uncomplicated pregnancy.

IV. MONITORING

The health care prm·iders shall be subjected ro the rules on monitoring and eYalu:1tion of performance as prm·idcd for in PhilHealtl1 Circular 54, s.20 12: ProYider F·:ngagcmcnr

through Accrcditauon and Cllntracting forHealth Sen·iccs (PL: .-\C:HeS).

V. REPEALING CLAUSE

VI. SEPARABILITY CLAUSE

In rhe event that· any part m prm-ision of tht~ Circular is declared unauth orized or rcnderctl invalid bv an\' Court of J ,;m- or compcrcnr authority, those prm'isions not affected by such declaration shall remain ,-alid and dfectJ\·e.

VII. EFFECTIVITY

This Cucular shall the S<1 m e cffectiYirr \nth PhilHealth Circular 34, s.2013. Further, thi s

I Phlliedtt I (Jill,.~ ... fiCEO I

·hall be publi shed in an · 11ewspapcr of general circulation and shall be deposited - wit·h th e a ional 1\ 1inis trati\'c Regis ter at the University of the Philippines] .a\\

Date:

REQUEST LETTER i\lODE OF PA YMJ ·:NT OF DESTROYED CL-\Ii\JS

DLTJZINC; ,\ FORTLTHOL;S EVENT

------------------Name o f Health Care Institution: --------------------------!\ ddress: --------------------------------------------

For the mode of pa yment of destroved chims, l here!)\' choose (check the appropriate box)

D 1. Reconstrucrion / recoven of de stroyed claims for subnussion / filing to PhilHealth within 120 calendar davs from date of discharge of patients for the cm·ered period (from (l()

days prior ro first day of occurrence of the fortuirom eYent up to the first day of occurrence of the fortuitous event).

OR

D 2. Payment of destroyed claims based on the average reimbursement per day n1.ultiplied by the number of days of th e coyerec.l period (from 60 davs prior to first day· of occurren ce of the fortuitous event up to the first da y of occurrence of the fortuitous event).From the computed :1mount, all claim s paid and received by the health care institutions for admitted and discharged patients within the C(wered period shall be deducted.

Sigmtturc ewer printed nam e 1\ feclical Director/ Chief of ! )o , pital / ;\u thorizecl RepresentatiYC

Important Ren1inders: 1. Choose ONLY ONE (1) option 2. The chosen option once approl'ed b_1 · the Corporation shall n o longer be changed.

FOR PHILHEALTH USE ONLY

LI-ll O PRO Date Received Received By

'

Signature over printed nnmc Signature m·er printed name